Provider Demographics
NPI:1760468029
Name:ALLERGY & ASTHMA ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:TAI
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-742-5730
Mailing Address - Street 1:8 HAWTHORNE PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2335
Mailing Address - Country:US
Mailing Address - Phone:617-742-5730
Mailing Address - Fax:617-742-6917
Practice Address - Street 1:8 HAWTHORNE PL
Practice Address - Street 2:SUITE 104
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2335
Practice Address - Country:US
Practice Address - Phone:617-742-5730
Practice Address - Fax:617-742-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53165207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9739939Medicaid
MAM15695OtherBLUE CROSS BLUE SHIELD MA
MA714337OtherTUFTS HEALTH PLAN
MAM15695OtherBLUE CROSS BLUE SHIELD MA